NURSING IN THE CASE OF ALZHEIMER'S DISEASE: PRESSURE SORES
Pressure sores used to be called bed sores because they were associated with a person lying for long periods in one position, in bed. As they also occur under other circumstances, for instance when a person is sitting for a prolonged period in a chair, and the factor common to the development of this type of sore is prolonged pressure, they have been renamed. This is more important than it may at first appear as it reminds one that prolonged pressure, of any kind, may result in the breakdown of the skin wherever this pressure is applied.
Areas that are particularly vulnerable are those sites on the body where skin is fairly close to bony projections and this includes the heels, the ankles, the buttocks, and the spine. Often the first indication that an area of skin is at risk of breaking down is a slight redness. The skin in older people is more fragile than in many younger people and this fragility is aggravated by inadequate nutrition and prolonged contact with moisture, perhaps occurring because of urinary incontinence. In the later stages of a dementing illness the sufferer is often relatively immobile, even if they can still walk a little and are not necessarily in bed or sitting down all the time.
Prevention is always better than cure. Relatively immobile people should be encouraged to get up and do something simple from time to time and not stay in the same position for more than an hour or so at a stretch. In theory a bed-bound person should be turned at least every two hours, but this is often not possible in the home environment and other means have to be used to take pressure off the danger areas, as described below. In particular, try to make sure that the confused person never sits with legs crossed all the time, particularly if the outside of one ankle is resting against the same area on the other.
There are many aids to prevent pressure sores developing, and these range from a simple sheepskin (or synthetic equivalent) for the seat of a chair or fashioned into the form of heel-protectors, to more complicated cushions or mattresses divided up into a large number of air-filled cells which inflate and deflate automatically, varying the points of the body that are subject to pressure. The local district nurse is usually an expert at prevention, as well as being skilled in the treatment of existing sores.